Radioimaging of Emphysematous Cholecystitis

1. Emphysematous
Cholecystitis
Pricilia Donna Esperansa Sea – 2012 060 106

2. Emphysematous Cholecystitis
• EC is a severe form of acute colesystitis.
• Rapidly fatal, risk for gangrene and perforation, high risk
mortality.
• Life-threathening anaerobic infection. Gas-forming
bacteria (Clostridium welchii/perfingrens, Escherichia
coli and Bacteroides fragilis)
• Men are affected twice as commonly as women. Mostly
patients are between 50 and 70 years of age, and have
underlying diabetes melitus.
• Can be detected using CT or USG. Gas in gallblader or
abnormal communication with GIT
• Pain in right upper quadrant.

3. Plain Abdominal Radiograph
Abdominal radiograph
(frontal projection)
shows intraluminal air
(arrow) with air–fluid
levels
http://www.ncbi.nlm.nih.gov/pmc/articles/P
MC3137852/#!po=50.0000

4. USG
Sagittal (A) and axial (B) USG images show
sludge (black arrow) and wall thickening
(arrow in A) of the gall bladder, consistent with
acute cholecystitis with echogenic shadowing
foci (arrow in B) within the biliary system
http://www.ncbi.nlm.nih.gov/pmc/articles/P
MC3137852/#!po=50.0000

5. Sagittal USG image of
the gall bladder shows
multiple speckled
echogenic bands
(arrows), with acoustic
shadowing within its
wall (arrowhead)
http://www.ncbi.nlm.nih.gov/pmc/articles/P
MC3137852/#!po=50.0000

6. CT
Axial CT scan shows
air (arrow) in the gall
bladder lumen with
an air–fluid level
http://www.ncbi.nlm.nih.gov/pmc/articles/P
MC3137852/#!po=50.0000

7. Axial CT scan shows
intramural air in the
gall bladder (arrow),
with cholelithiasis
(arrowhead)
http://www.ncbi.nlm.nih.gov/pmc/articles/P
MC3137852/#!po=50.0000

8. Emphysematous cholecystitis in a 47-year-old man with diabetes who experienced
abdominal pain. This computerized tomography scan shows gas within the wall of
the gallbladder (horizontal arrow) as well as within the lumen of the gallbladder
(verticalarrow).CourtesyofHelenMorehouse,MD.
http://emedicine.medscape.com/article/173885-
overview#aw2aab6c10

9. Axial CT scan (A) shows an inflamed gall bladder with questionable air in the
gall bladder wall (arrow). Coronal reformation (B) confirms air within the gall
bladder wall (arrow) suggesting emphysematous cholecystitis
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC31
37852/#!po=50.0000

10. MRI
Coronal heavily T2-weighted
magnetic resonance image shows
numerous signal void bubbles
(arrowheads) in the lumina of the
distended gallbladder and the
common bile duct.
Courtesy of Radiological Society of
North America (RSNA), originally
published in Watanabe Y,
Nagayama M, Okumura A, et al.
MR imaging of acute biliary
disorders. RadioGraphics
2007;27:477-95.
http://emedicine.medscape.com/article/173885-
overview#aw2aab6c10

11. Daftar Pustaka
• Emphysematous Cholecystitis. April 9, 2015 [cited May 12, 2015];
Retrieved from: http://emedicine.medscape.com/article/173885-
overview
• Sunnapwar A, Raut AA, Nagar AM, Katre R. Emphysematous
cholecystitis: Imaging findings in nine patients. Indian J Radiol
Imaging. 2011;21(2):142–6.
• http://radiopaedia.org/articles/emphysematous-cholecystitis